Inspection on 14/06/05 for 239 Boxley Road

This inspection was carried out on 14th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

239 Boxley Road 30/11/07

239 Boxley Road 19/12/06

239 Boxley Road 18/10/05

239 Boxley Road 08/10/04

239 Boxley Road 26/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 239 Boxley Road Maidstone Kent ME14 2BG Lead Inspector Lynnette Gajjar Announced 14 June 2005 09:36 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 239 Boxley Road Address Maidstone Kent ME14 2BG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01622 764979 01622 686457 Mrs Lorna OShea Mrs Linda Sharon Cochrane CRH Care Home 10 Category(ies) of LD Learning Disability registration, with number of places 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8 October 2004 Brief Description of the Service: 239, Boxley Road is a detached property in Maidstone. The home is situated on the outskirts of Maidstone town centre with easy access to public transport. Boxley Road statement of purpose promotes their aims to offer support and advice to teach adults with Learning Disabilities to achieve personal independence to the best of their abilities. Resident’s private accommodation is on the first and second floors consisting of 8 single rooms (two of which have en-suite facilities) and 1 double room. These floors are accessible only by the stairs; the home does not have a lift. The ground floor accommodates the kitchen, dining room, laundry area, staff office, main lounge and small private lounge. Bathrooms are located on the ground and first floor. The home has a small garden and garage, with car parking for two cars. There is road parking in the streets around the home but this parking is restricted to two hours. 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, the first in the year running from April 1st 2005 to March 31st 2006. The inspection took place on 14th June 2005 and the visit lasted from 9:36am to 16:50pm. The pharmacy inspector was present at the beginning on the visit to assess and advise regarding medication processes. The home currently has nine service users and is running with one vacancy. Time was spent speaking with eight residents collectively and privately, staff, the manager, service manager and owner. Additional information was obtained through receipt of the manager’s pre inspection questionnaire, a tour of the premises, perusal of policies and procedures and conducting a case tracking exercise, by reading the care plans of the two residents. Comment cards feedback was also received from residents, their relatives, care managers, GP and other professionals working with the home. The home was clean and well maintained. Documentation was on the whole in good order and the requirements and recommendations from the previous inspection had been implemented. Residents appeared relaxed and happy. What the service does well: What has improved since the last inspection? Risk assessments and care plans continue to develop ensuring residents safety, whilst allowing opportunities to grow and be independent. The kitchen refurbishment has enabled residents and staff to promote and maintain good safe food storage and preparation. 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 6 Residents stated they felt safe and secure at the home and locally from both staff and peers support. Further plans are being discussed to convert the top room into two single rooms with en-suite to enable all bedrooms at the home to be for single occupancy and no longer have a shared bedroom, offering residents more privacy and personal space. Residents are now benefiting from having a stable management team who work well together to promote open and resident led service. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4, Prospective residents and their families are given all the information they need to make an informed choice about whether to move into 239 Boxely Road. EVIDENCE: A clear procedure is followed for all new admissions into the home. Written evidence in care files supports that care managers; the resident and family members all contribute in providing current and necessary information. The homes statement of purpose and residents guide give clear information about the services provided. These are in both written word and object reference pictorial formats. Residents openly discussed their induction to the home. With great reflection and stories about visits for tea over a period of time to having short overnights stays and meeting with their care manager before deciding to move into the home. All residents spoken with felt they were involved, when a new person was planning to move into the home and they talked to the manager and service manager openly about how it would affect them. 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9,10 Care plans and risk assessments are developing to keep residents safe, whilst allowing opportunities to grow and be independent. Residents feel they are involved in making decisions about their lives. Resident’s have a real sense of ownership about their home and trust that staff maintain their confidences. EVIDENCE: Two individual care plans were inspected. Goals and care needs have been expanded to be clear and in appropriate language. Those seen are monitored and regularly reviewed. Residents told the inspector that they know the contents and have set agreed the targets with support of the manager. All of the residents lead busy lives, which present challenges, risks and the opportunity to make mistakes. Increasing independence is a key aspect of the home’s aims for its residents. One resident is currently exploring moving on into supported living scheme to offer more independence and personal achievement. Regular house meetings enable residents to make own views known and all such meetings are recorded in writing. Residents’ activities and wishes determine mealtimes, menus, holiday venues, décor and activities. Staff have a good understanding in the handling of confidential information. They know when and how such information should be ‘passed on’. The inspector observed close, positive interaction between staff and residents, 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 10 enabling residents to feel genuinely liked and respected. Closed working is identified and encouraged through the adult advocacy support. 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15,16, Resident’s access a wide and varied range of leisure, work and education opportunities within the local community offering personal development and high self esteem. Important relationships are respected; encouraged and residents feel valued. Staff encourage individuals to take responsibility for their own actions. EVIDENCE: Specific hobbies and interests of individuals are identified and they are supported to follow these at a pace suitable to them. The home has plenty of leisure equipment and resources within the lounge and quiet room. There are three communal rooms enabling people to choose whether to be alone or join in with the others. Shops and pubs are within walking distance and the town of Maidstone is easily accessible by public transport and car, therefore leisure centres, cinemas and restaurants are easily visited. Residents talked to the inspector about aspects of their lives that were important to them including, “going to work, college and adult education classes”, “seeing my boyfriend/girlfriend” “ going to visit my family” and “going on holiday ”. Residents enjoy additional outings provided by the outreach support staff, to larger events such as special cricket, football matches, speedway, shows only monthly basis. 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 12 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20,21 Residents feel they have and continue to be well-supported to understand and managed their feelings following the death of a one of their close friends. Appropriate health care is encouraged and maintained. Residents would benefit further from clearer medication protocols and dispensing systems to minimise the risk of error when medication is given. EVIDENCE: Some residents require more personal care than others. For those that do, care plans clearly detail how and under what circumstances this support should be delivered. Staff spoken to demonstrated a sound understanding as to how they would ensure privacy and dignity at such times although through discussion with residents they did not always feel this happened in practice. At present, no residents control and administer their own medication. Systems currently in place have not been working and errors have occurred resulting in disciplinary action for staff and missed medication for residents. The manager and staff are keen to take this forward with an openness for support and guidance to put new systems in place to improve medication administration. Development of the homes procedures: for visits/holidays, dispensing method on blister pack files is to be reviewed with Boot Chemist. The staff and residents have supported a fellow resident through a difficult and serious illness, working closely with the GP, Practice Nurse and Care Management to ensure that their health and social care needs continue to be met, aspirations achieved and to pass their last days at the home with friends and colleagues 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 14 around them. Residents discussed in detail today their feelings around this and how they have been supported to talk about, visit and lay flowers and to grieve the loss of a good friend with sincere respect and dignity. The additional staffing support and understanding from the organisation and staff at this very difficult time is highly commendable. 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Residents have ample opportunities to express their views. They feel they are listened to, valued and concerns acted upon. Clear procedures are in place to ensure residents are protected from abuse, neglect and self – harm. EVIDENCE: Resident’s meetings are held by an external advocate and are recorded in writing. All of those spoken with stated that these and individual key worker sessions are meaningful and worthwhile. None of the residents are afraid to make suggestions and comments. In fact, the inspector observed how confident people were in expressing own views, through the culture that exists within the home, particularly towards the proprietor. Residents know how to complain and so do family members and visitors. Residents were seen directly to raise concerns to the manager and being supported to achieve a satisfactory resolve. The home implements clear and specific guidance for staff and external training courses are accessed. These measures and the use of clear risk assessments, protect residents, staff and visitors from abuse and accusations. Staff have been open and raised an adult protection alert since the last inspection that is being investigated and monitored by local Social Services. Residents stated they felt safe and secure at the home and locally from both staff and peers support. 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,30 Residents live in a clean and homely environment. Bedrooms are very much ‘owned’ by the occupant and are furnished in a way that best meets their needs and promotes independence. There is ample communal space, accessed and enjoyed by all. EVIDENCE: The home is spacious and regularly maintained. All bar one bedroom is single but all are personalised in accordance with the occupant’s wishes. All residents can lock their bedroom doors, with a number bringing in their own furniture and possessions when they first moved in. Communal areas include a large kitchen – completely refurbished since the last inspection, dining room, lounge, quiet room and a small rear garden. All of these areas are accessible to everyone. Bathrooms are in need of an upgrade and attention. The home has proposals to adapt the second floor flat to, two single rooms with en-suite facilities to enable the current double bedroom to become a single but the home continuing to offer care for 10 residents. This is planned for later this year. The conservatory has been upgraded and new sink installed here due to the washing machine being located here. All parts of the home are open and accessible to the residents, except their private rooms and the office. 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 17 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,34,35,36 Clear lines of accountability and responsibility are followed and residents know exactly who to talk to. Staff receive an induction and all are now having regular, documented supervision meetings. EVIDENCE: All staff have clear and specific job descriptions, contracts and residents know and understand the roles and responsibilities of their carers. Staff are familiar with care plans and what they mean in terms of their own practice. Individual personnel files were randomly selected in order to explore the home’s recruitment procedure. This was sound, however, due to a misunderstanding of the CRB procedures a new CRB had not been applied for when a staff member was transferred from another part of the organisation. The managers addressed this immediately. A full satisfactory CRB had been received for their previous role. A rolling programme of training is in place, however new training co-ordinator is currently being recruited. Staff felt disappointed and devalued through the demise of their NVQ assessors and poor support received. The organisation are currently in negotiation to appoint new body and assessors to take this forward for the 2 staff currently on hold. No staff currently holds a NVQ 2 award. Two staff files were assessed and satisfactory checks and references have taken place at the time of recruitment. 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 19 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,42,43 Resident’s personal preferences support and care needs are encouraged through the registered manager and service managers open leadership and the promotion of a safe home and working environment. EVIDENCE: The registered manager has worked with this service user group for many years and is currently working through the Registered Managers Award NVQ 4. Residents and staff expressed a satisfaction towards their management approach to the home. Residents felt the registered manager was approachable and staff said they felt well supported. The registered manager and service manager demonstrated through discussion, clear understanding of the needs of current residents and current issues. Monitoring health and safety in the home is to a good standard, with regular health and safety walking routes taking place, and equipment serviced as required to maintain a safe home and facilities. Risk assessments continue to develop individuals and staff activities in the home and care duties. Staff evidenced a clear understanding of accident/incident recording and reporting under regulation 37 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 21 to the commission. Residents clearly understand the management structure and who to approach to support them at specific times. 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 2 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score 3 x x 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 239 Boxley Road Score 3 3 2 4 Standard No 37 38 39 40 41 42 43 Score 2 3 x x x 2 3 H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 34 Regulation 19 Requirement The registered person shall not allow a person to to work at the care home unless the employer has obtained in respect of that person the information and documentation specified in paragraphs 1-6 of schedule 2 and where paragraph 7 applies, paragraph 8 of that schedule. In that all staff even when transferred or promoted to a new post with in the organisation must make a new application for and received satisfactory CRB disclosures in respect of that post. Timescale for action 3Oth June 2005. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA6 Good Practice Recommendations Develop care plans to be more personalised to residents aspirations and goals as well as the direct care such as personal hygiene, road safety, cooking. On going It is recommended that care plans are translated in H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 24 239 Boxley Road 3. YA9 4. YA20 5. YA34 6. YA35 7. YA42 foramts that are easiy to understand and follow for individual residents personal needs. Risk assessments are developed further to be more personalised to residents, their aspirations and goals as well as the generic care risk assessments such as road safety, personal hygiene and cooking. Ongoing It is recommended for good practise in administration and recording of medicines that:· The medication policy should be reviewed to ensure that it include protocols for medication storage, recording and administration for home visits / holidays, but also to include details of the G.P and Pharmacies.· Reviewing current practice for visit/ holidays must be undertaken to ensure medication is dispensed from original containers and not decanted into alternative pots / bottles.· Guidance for prescribed medication currently held in the care plans (including PRN) should be stored with MAR Sheets.· When PRN medication is administered this should be recorded on the back of the original MAR sheet.· The home obtains a recent copy of BNF that is within six-month date from issue and replaced every six months.· Medications dispensed and directed for regular administration must be undertaken unless a full review with the G.P has taken place and medication reviewed and agreed to be administered PRN only. Medication must be administered as stated on the MAR direction.· Medication must be stored in correct boxes and All medication received bottles that are clearly labelled.· and returned must be recorded.· Handwritten entries to MAR sheets should be countered signed to confirm accuracy. It is recommended that verbal checks followed up for written references and spot checks on courses stated to have been attended by applying new staff for confirmation of validity. It is recommended that 50 of care staff be NVQ2 /3 trained by 2005There was evidence of the organisation continuing to work towards this target. The remains a recommendation from today’s inspection It is recommended that more formal recorded auditing and monitoring systems be implemented in relation to incidents and accidents occurring in the home. 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 239 Boxley Road H56-H06 S23869 239 Boxley Rd V223513 140605 Stage 4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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